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The Best Science Writing Online 2012
Showcasing more than fifty of the most provocative, original, and significant online essays from 2011, The Best Science Writing Online 2012 will change the way...
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The Supreme Court ruled today to uphold the 2010 Affordable Care Act (ACA), which aims to expand health insurance coverage to 32 million more Americans. However, the Court also ruled that the federal government may not penalize states that decline to participate in the expansion of Medicaid that accompanies the ACA by taking away other Medicaid moneys.
The Court, which heard arguments on the case in March, decided that the law's provisions, including the individual mandate and the expansion of Medicaid, are, indeed, constitutional. While several Justices thought the individual mandate could be struck down under the Commerce Clause of the Constitution, the majority of them held that the penalty for not getting health insurance was in effect a tax—which the federal government has the power to levy.
Most people would have already met the requirements of the "minimum essential coverage" provision via employer-provided health insurance or federal coverage, such as Medicare or Medicaid. The individual mandate requires most Americans to be covered by health insurance or a federal program, such as Medicare or Medicaid, by 2014 or else pay a small penalty. (People who spend more than 8 percent of their annual incomes on premiums and other select groups will be exempt from the mandate.)
With the Medicaid expansion, an additional 16 million people, many well above the poverty line, are also expected to gain insurance coverage in the next several years—provided that the states in which they pay their share of the expansion costs (Medicaid is funded out of both federal and state budgets).
The extended uncertainty leading up to the Court's ultimate decision forced many states and companies to chart their own courses in the chaotic health care waters.
Some states have been determined to continue on the path toward their own localized changes whatever the national ruling. California, for example, decided to institute insurance exchanges anyway; other states, such as Vermont, might follow Massachusetts's lead and establish their own individual mandates. And several of the largest insurance companies, including Aetna and UnitedHealth Group, said they would continue offering many popular benefits already in place from ACA, such as allowing young people under 26 to remain on their parents' insurance plan.
Other states, such as Florida and Texas, which have opposed many of the law's provisions while it was in legal jeopardy, might have to scramble to prepare for the insurance exchanges.
As legal and political scholars have pointed out, however, the fate of the health care law rests perhaps even more on the elections in November than on this ruling.
Although the state-based health care system Mitt Romney set up as governor of Massachusetts served in part as a model for the Obama plan, the Republican front-runner has asserted that if elected in November, he will "repeal and replace" the law. In a speech earlier this month in Orlando Fla., Romney noted, "It's important for us, in my view, to make sure that every American has access to good health care." He suggested that a better way to do that is by allowing states to create their own solutions without requiring them to provide coverage for their residents.
What is clear is that something will have to change. Health costs have exploded to 10 times their 1980 levels in just 30 years and are projected to continue to increase dramatically into the future. In 2010 costs approached $2.6 trillion, which is about a fifth of all U.S. spending combined. The largest chunk of the health care pie (31 percent) went to hospital care, according to the Kaiser Family Foundation, a nonpartisan policy analysis organization. That number would likely decrease if more people were able to obtain earlier, preventive care.
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29 Comments
Add CommentBravo ! Healthcare even for the poor is needed. I hope you find a way that this care is not missused, as it happens sometime here in austria. Dr.Kamlander.@aon.at
Reply | Report Abuse | Link to this"He suggested that a better way to do that is by allowing states to create their own solutions without requiring them to provide coverage for their residents." (Romney)
Reply | Report Abuse | Link to thisThere is a problem with that. Oregon provided health care to anyone regardless of family status. That meant that single people who could not afford insurance (homeless, unemployed) could get it in Oregon but not in California or Idaho. The state was overrun with people moving in from neighboring states for the health insurance. We had to shut it down and now you have to have a child, a disablity or take part in a lottery to get the state level insurance. There for a while, Oregon could not even cover all of its children. So if only some states take part in the program, will poor people move to those states to get insurance? How will this affect the financial demographics of those states? Will we wind up with haves and have nots at a state level?
Dont get me wrong, I love this law. I finally get to go see a doctor. I currently work full time as a server, am in my 40's and have never had regular access to medical care, unless of course all or some part of my reproductive organs were involved.
I do have some concerns, like price gouging. Now that insurance companies have a captive consumer base, will insurance companies raise thier prices? If they do raise them, then many people will just choose to pay the fine/tax, becasue it costs less and the system wont work because the whole idea is to spread out the risks.
I would like to see more oversight and much more control of the insurance carriers in this system, or even better, move to a direct pay system where we cut out the insurance companies and just pay the same premiums to the hospital or clinic directly. Right now it just seems like a way to make a lot of insurance companies very rich at the expense of sick people and doctors.
Why is this a topic? Can't we keep internal U.S. domnestic politics off of this site?
Reply | Report Abuse | Link to thisrogueokie wrote, "move to a direct pay system where we cut out the insurance companies and just pay the same premiums to the hospital or clinic directly."
Reply | Report Abuse | Link to thisMaybe you should give that a second thought to understand why that would not work. Do you believe that a single entity can provide all your health care needs? What if you can not make to that specific hospital or clinic that you are paying? And whomever you pay has to be big (with many, many customers).
People fail to understand how health insurance is not like auto insurance. Health risks go up as we age. It is logical that a healthy person in their 20s would be unwilling pay high premiums that need to account for the healthcare costs for the elderly. It's all about moral hazard that the market is unable to accomodate. Without Medicare the elderly are uninsurable because the risks are too high and it becomes impossible in a free marketplace to push these costs to younger people who have lower health risks. Medicare attempts to do this, but only half way -- primarily because healthcare inflation is much more than wage inflation (which is taxed). The only answer is Medicare for all.
Cramer, you will not have to wait long for your dream of single payer. The current law will do nothing to control costs. the resulting spiral will leave only one option. this of course if fully intentional.
Reply | Report Abuse | Link to thisHaving worked inside a single payer system I can assure you I will be able to get all the health care I want for me and my family. The problem is you will not get yours: that is the problem. I sometimes wonder why I fight to protect you from your own ignorance.
ssm1959 wrote, "Having worked inside a single payer system I can assure you I will be able to get all the health care I want for me and my family. The problem is you will not get yours: that is the problem. I sometimes wonder why I fight to protect you from your own ignorance."
Reply | Report Abuse | Link to thisWhat "single payer system" have you "worked inside?" I will definitely get my healthcare with or without insurance. My high networth guarantees that. Are you saying you will get your healthcare by "working on the inside" (I guess that means through corruption?)?
It's telling that you must use ad hominems to support your position. You did not say much else, so I guess that's all you have. Does our current system do anything to control costs? Please elaborate on your "spiral." Give the readers of SciAm more details on your economic theory rather than bumper sticker cliches. So far you have said nothing.
Hawaii has some of the most liberal healthcare laws in the country. Guess what? Hawaii also has some of the healthiest people in the country. Oh, and lest I forget, Hawaii also has one of the lowest unemployment rates in the country and the corporations are not all bankrupt after decades of mandated healthcare laws.
Reply | Report Abuse | Link to thisAll you know-it-all whiners quit it already. Take you medicine!
Trying to compare Hawaii, a small island chain isolated in the Pacific to the continental Unites States is like trying to compare grapes to blue whales.
Reply | Report Abuse | Link to thisSeems to be a world wide trend to not spend any money on prevention and then spend way more on trying to fix the problem later on.
Reply | Report Abuse | Link to thisThis is what really needs to be fixed: "Health costs have exploded to 10 times their 1980 levels in just 30 years and are projected to continue to increase dramatically into the future." - some cost reduction items are in the bill but much more needs to be done. Getting more people covered is not going to solve the problem that health care is a massive expenditure in the US, it will simply put more money into the big pool that will then get drained off into pockets that don't deserve it.
Reply | Report Abuse | Link to thisTrue. You need to be more intelligent then the average American just to afford to live in Hawaii.
Reply | Report Abuse | Link to thisYou make a very valid point. This is exactly why healthcare should not be a private insurance funded industry. Private insurance companies are not the least bit interested in cutting costs. They make their money based on a percentage of the money flowing through their banks. It's called profit and the higher the bill the more they charge for premiums and more profit they make. Where they really make a killing (literally speaking) is denying payments to people who have paid in for years and preexisting conditions and then loose their insurance.
Reply | Report Abuse | Link to thisThe Affordable Healthcare Act was the best news I have heard for ever for many of my friends in that sinking boat.
Science related news? PLEASE? PLEASE? I formally request that you stop putting political crud on this site. I have all sorts of aggregators for domestic U.S. news, please don't degrade this into another entertainment and political commentary site.
Reply | Report Abuse | Link to thisI agree with oldfurr & gellyroll that the domestic politics really don't belong here but I suspect that the Progressive editorial staff does not see it that way.
Reply | Report Abuse | Link to thisIt is obvious that Progressive agendas like the Health Care Act as well as Global Warming (or is it Climate Change?), Green Energy, Battery Cars, Bad Oil and Even Badder Coal are a part of this site - like it or not.
I miss the days of the old SA... (heavy sigh)
When was it "Scientific American" ceased to be either "Scientific" or "American"?
Reply | Report Abuse | Link to thisQuite correct; politics is not science, and Obama's politics are not American.
Reply | Report Abuse | Link to thisQuite correct!
Reply | Report Abuse | Link to thisAs the most unscientific, unamerican poster I have read, you really have a talent for calling the kettle black.
Reply | Report Abuse | Link to thisdenverjims, I believe the correct term is no longer "climate change" but "random natural worldwide weather fluctuations."
Reply | Report Abuse | Link to thisBut don't take my word, you should ask your conservative peers since the conservatives are most concerned with the "political correctness" of the issues. Or talk to the the people who finance this propaganda, such as the Koch brothers, Fox News, American Crossroads, Heritage Foundation, etc.
Here are a few more examples:
slavery became "Atlantic triangular trade"
torture became "enhanced interrogation techniques"
sea level rise became "recurrent flooding"
mercenary became "private military contractor"
wealthy people became "job creators"
global warming became "climate change" to become "random natural worldwide weather fluctuations"
If this "law" was such a good idea, why did it have to be mandated and compulsory? So good that we all have to be forced to pay for it. I am sick to GD death of reading BS like this in SA. So much for science...
Reply | Report Abuse | Link to thisLet's stick to science and leave this BS to the "news" sites.
SA: Your political stances are getting seriously old.
Likewise, if the Iraq War was such a good idea, why am I being forced to pay for it?
Reply | Report Abuse | Link to thisUnlike the Iraq War which we are all paying for (some with their lives), only some of the people w/o health insurance are being "forced" to pay for their own insurance. Ask Romney, it was his idea. I thought you conservatives hated freeloaders. That's what it is when someone shows up in an emergency room w/o the ability to pay. Conservatives are zombies who march to the orders of the elite. In 2006 when this healthcare plan was a Republican plan, it was good. When it's from Obama, it's bad. Wake up, zombies! Listen to someone besides Glen Beck and Rush Limbaugh.
Nope, it wasn't a good idea then either...and I do hate freeloaders. We all should. And we shouldn't pay for them. The point of the argument isn't really whether people should have health insurance: it's whether or not the federal govenment should be able to force you to buy something you don't want (oh, and it's still not making everybody pay)
Reply | Report Abuse | Link to thisLastly, and most importantly, this doesn't belong in SA, neither does the Iraq or Ashcanistan wars. That's my point.
Nope, everybody pays. Currently, people either pay through increased costs in their healthcare bills to cover the poor for emergency room visits, or through a more rationed, less efficient healthcare system because they can't afford anything better.
Reply | Report Abuse | Link to thisThanks to Ronald Reagan, the great Socialist in Chief, everybody in the nation is paying the costs of emergency room visits because Reagan signed a law stating hospitals could no longer turn the poor away in case of emergencies. This is the most inefficient system in the developed world, guaranteeing poorer results for all and higher costs for all.
If you think the poor are freeloaders, feel free to move to a country that shares this philosophy, I hear Somalia's easy to get into.
Though I agree this doesn't belong in SA.
Don Quixote wrote, "Lastly, and most importantly, this doesn't belong in SA, neither does the Iraq or Ashcanistan wars. That's my point."
Reply | Report Abuse | Link to thisIf you actually wanted to make the point that this topic does not belong in SA, then you should not have INJECTED YOUR POLITICAL OPINION ON THIS TOPIC. You can't have it both ways. Otherwise, that's hypocricy.
With the population equally divided on the value of the Health Care Law , a very narrow margin will decide its fate in November and it is essential that every voter understand the law, and how it applies to them as an individual. Political propaganda will not help, it will only misslead.
Reply | Report Abuse | Link to thisThe law is specific in its application and how it applies to a limited number of situations. I would love to see a government web site (isolated from propaganda copy cats), where a citizen can enter the specifics of his or her situation and see exactly how the law will affect them. Only in this way can we can we isolate this issue from other election issues already buried in the mud of big money politics.
Democracy can prevail only when its citizens are well informed. It will not prevail if misinformation and emotional catch words continue to cloud the real issues.
Citizens, listen with an open mind to both sides, not just one, and make an informed decission. Let reason not hate determine your vote.
Politicians examine your own goals and words more carefully. Your advisors have analysed every aspect of the voting population and know what words in what places will have the greates impact, but are they your words? Please, be of good council and follow your own concience so we, the public, can cast an informed vote. Make us proud of our Country and its leaders again. Teach us to respect our laws regardless of their originators and to be respectful of the responsibility of holding high office, regardless of the occupant's politics. Pledge yourself first to us, the citizens, second to the responsibilities of your office, third to your political party and never to those who finace you or who solicit your support for hidden agendas.
Commenters need to quit posting their political opinions on SA if they object to SA publishing political articles that they believe have little to do with science.
Reply | Report Abuse | Link to thisIt does not make sense to object to SA publishing an article on healthcare, then also post your own political opinion on healthcare.
Myself. I have no problem with SA publishing this article. Public policy definitely does influence science and occassionally vice-versa. And economics is a science, though a soft one due to the inability to control variables in experimentation.
Canadians with means travel south to obtain health care in the U.S. because with Canada's single payor system you can wait for a procedure until you die. Free market = Efficiency Gov't mandates = One bloody mess
Reply | Report Abuse | Link to thisOops, Congress forgot something. Those geniuses will have us lean, fit, strong men paying for the super-expensive care of cigarette-chomping fatties and couch potatoes. Whatever happened to "personal responsibility?"
For all those who don't believe healthcare is a science issue, tell that to all the researchers who depend on private and public grants to continue their work.
Reply | Report Abuse | Link to thisBTW, If only rich people could afford the new drugs and surgical procedures, 90% of the companies and hospitals business would be gone. There would be much less incentive to improve anything in the healthcare industry.
Health IS a science issue. The "Affordable Healthcare Act" is not remotely a science issue. It is entirely a political issue. You are correct, healthcare research is funded by both private and public dollars. If it were only funded by private dollars we would experience much greater efficiency (and less regulation). I'm 100% confident that you pulled the psuedo-statistic of 90% out of, well, somewhere other than a reputable source. If only rich people could buy drugs, the cost of of healthcare would drop due to no market. As a result, there would be tremendous incentive to improve. That is the way the free market has demonstrably worked, and quite successfully here. We need everyone to simply be responsible for themselves and their own healthcare. My two cents...
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